Data sources

Randomised controlled trials were identified by using Medline, EMBASE/Excerpta Medica, handsearches of journals, bibliographies
of reviews and identified trials, and contact with principal investigators of trials. The search strategy produced by the
Cochrane Review Group on Peripheral Vascular Diseases was used.

Study selection

Trials were included if exercise programmes were compared with control or medical or surgical treatment; participants had
self reported or clinically diagnosed intermittent claudication caused by atherosclerotic disease; the exercise programme
included any form of leg physical activity (eg, walking or running); and outcomes were provided (treadmill walking distance,
time to onset of pain, maximal walking distance, mortality, cardiovascular events, disease progression, indirect tests of
disease such as ankle pressure measurements, and subjective measures such as symptom progression).

Main results

10 trials (involving approximately 250 patients) met the inclusion and quality criteria. 3 trials compared exercise with placebo
tablets, 3 trials used normal activity as the control programme, 2 trials compared exercise with drugs (antiplatelet agents
and pentoxifylline), and 2 compared exercise with arterial reconstruction surgery or angioplasty. All programmes recommended
≥2 sessions of exercise per week. Duration of the programmes was 3–12 months, and follow up ranged from 12 weeks to 15 months.
Exercise increased walking times compared with usual care or placebo, angioplasty, and antiplatelet therapy. Pentoxifylline
was better than exercise for walking times in 1 small trial, and no difference was shown between exercise and surgery (table).

It is estimated that more than 12 million people have peripheral arterial disease,1 and approximately half of these have intermittent claudication. Although many people have these conditions, relatively little
attention has focused on the resulting disability. The review by Leng et al summarises the best literature on treating intermittent claudication with exercise programmes, an intervention that has been
shown to effectively reduce the disability of intermittent claudication.

This high quality systematic review provides a clear description of the methods used for the selection of trials. Data were
independently extracted by 2 reviewers. One area that should receive more attention is the effect of exercise programmes on
health related quality of life. This issue is important to patients and is an important marker of efficacy.

The results are relevant to nurses who work in cardiac rehabilitation settings and those who are specialists in vascular and
cardiovascular areas. Peripheral artery disease causes functional disability and patients may be unable to complete normal
daily activities. As the population ages, the prevalence of intermittent claudication is likely to increase. More effort should
be directed toward providing interventions that will help to alleviate symptoms and improve functional ability in patients
with this condition. Questions that arise from the Leng review and that provide opportunity for further research are: (1)
what is the sustainability of the observed changes after the intervention ends? (2) Is a home based programme as effective?
And, (3) what is the effect of walking success on patient self efficacy and long term behaviour change? The ability of nurses
to recognise peripheral artery disease, to acknowledge its associated disability, and to understand the efficacy of well structured
exercise rehabilitation programmes will improve care and promote patient wellbeing.